Provider Demographics
NPI:1750354510
Name:HANNON, TAMARA S (MD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:S
Last Name:HANNON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 5960
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-3889
Practice Address - Fax:317-944-3882
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN010686622080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200372190Medicaid
INM400045481Medicare PIN
IN200372190Medicaid